| NPI | 1932636651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2022-00453) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 90143) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-09-28 |